Filed under Effectiveness

A perennial criticism of capitalism is that it turns labour, through which we ought to find fulfilment and self-realisation into mere drudgery. As Oscar Wilde put it, “The chief advantage that would result from the establishment of Socialism is, undoubtedly, the fact that Socialism would relieve us from that sordid necessity of living for others”.

Today, as in Wilde’s time, most people live for others. They have a limited set of marketable skills, and so spend their working lives providing whatever service the market requires, regardless of how they would choose to spend their time. I have always felt incredibly fortunate to have a wide range of options open to me, to know that my career was a matter of choice, rather than something I had to do to get by. I tried to remain conscious of the fact I could work as much for myself as for others, and that I should value this freedom because it is so unusual.

The concept of professional philanthropy turns this reasoning on its head. It suggests that as long as we live in a world so unequal that genuine career choice is a luxury, it is immoral to take advantage of it. For as long as we live in a world where money has the capacity to do such good – in terms of reducing inequality, preventing disease, providing education – it is self-indulgent to turn your back on it.

The uneasiness I feel about giving up my freedom to work only for myself reminds me of the argument my mother made to me as a child when I refused to finish my dinner (I’m sure many of you had similar conversations). ‘Think of all the starving people who are desperate for that food you’re about to throw away’, she would say. Her point, of course, was that if other people value it so much, so should I. To do otherwise would show a lack of respect and humility. My response was that if they wanted the food so much, they should have it – my eating it wouldn’t make them any better off.

As long as it was impossible for the food to be given to the impoverished my mother’s argument was valid, and mine invalid – the best way to respect the destitute would be to acknowledge my good fortune. But if (as was probably the case when we lived in Kolkata, come to think of it), it would be viable to transfer the food to the poor, then my argument surely makes more sense – it would surely show them more respect to feed them than to eat food in their honour.

I think a similar argument applies to luxury of career choice. For as long as we think that self-realisation is bound to be limited to a lucky few, then the appropriate response is to savour it. But if there is hope of extending it to others, then the best use of our good fortune is to sacrifice it.

 Aveek Bhattacharya

Giving What We Can’s assistant director and head of research, Will Crouch, has today published a letter in the Financial Times, highlighting the problems with the government’s current conception of ‘value for money’ and ‘cost-effectiveness’ in the field of foreign aid. You can read the article here:

Some excertps:

 The UK’s Department for International Development refers to “value for money” when describing its priorities. But it doesn’t have a sensible metric for what counts as “value”, even though health economists do: namely, the Disability Adjusted Life Year, or DALY…

Using this metric, there has been excellent research… applying the scientific method to development in order to work out which programmes help people the most with every pound spent on them…

By funding the rotavirus and pneumococcal vaccines, it is paying $100 for every DALY averted… If the government were to increase funding to child deworming, it would pay only $3.41 for every DALY averted. In comparison with these vaccinations, deworming is like a 96 per cent off sale, or 3,000 per cent extra free. That’s value for money.

This research is never explicitly mentioned on DfID’s priority list, and is either being ignored or not taken seriously enough. Because of this, some of the most cost-effective – but unsexy – interventions, like deworming schoolchildren and promoting handwashing with soap, are neglected.

Margaret Chan, director general of the WHO, has stressed the importance of basic sanitation in her address to the World Health Assembly. Here is an article about sanitation on the Guardian’s “Poverty Matters” blog.

It might seem that sanitation programs would be highly cost effective:

• Approximately 10% of the world’s diseases could be prevented by good sanitation (Chan).
• Hand-washing with soap at critical times can reduce the incidence of diarrhoea by up to 47%. (UN Water). An important finding, given that diarrhoea kills one child every twenty seconds.
• The integrated approach of providing water, sanitation and hygiene reduces the number of deaths caused by diarrhoeal diseases by an average of 65% (WHO)*
• For every $1 invested in water and sanitation, $8 is returned in increased productivity (UNDP)
• Lack of safe water and sanitation costs sub-Saharan Africa around 5% of its Gross Domestic Produce (GDP) each year (UNDP)
• 443 million school days are lost each year due to water-related diseases (UNPP)
• 11% more girls attend school when sanitation is available. (UK DFID)
• 15 pounds can be enough to provide someone access to safe water, improved hygiene and sanitation (WaterAid)

However, Giving What We Can has found that huge and important differences in the cost effectiveness of

a) Construction Programs (the construction of infastructure to improve water supplies)

b) Promotion Programs (the promotion of good sanitation and hygiene practices)

Construction programs are less than a tenth as efficient as some health interventions, and is thus not a top-recommended intervention.

Promoting sanitation practices, and even more so promoting hygiene practices like handwashing, is, however, highly cost-effective. It may be as cost-effective as the treatment of neglected tropical diseases.

We are thus undergoing further research into the cost-effectiveness of hygiene promotion. However, as of yet, we do not know of any charities that focus solely on hygiene promotion, so are not able to make recommendations.

See our short explanation of the cost-effectiveness of water and sanitation interventions here.

Yahoo! “news” has published an interview with Oxfam’s chief executive, Barbara Stocking. It gives an insight into how Oxfam’s top management consider and decide between different aid projects and goals, with a particular focus on the relationship between political/ security aims and development aims.

On this second issue, the article includes the following quote from David Cameron, from a speech to the House of Commons last week:

“We need to broaden the argument for the aid budget. We should say quite clearly the DfID budget is also about conflict prevention and trying to stop things upstream that would cost us more downstream. Often the modern equivalent of the battleship is the C-17 loaded with aid.”

And the modern equivalent of aid is…?

The UK government says “we will stick to the rules laid down by the OECD about what spending counts as aid.”

However, as the article highlights:

The problem is that if Britain meets its requirements to the letter it will actually be downgrading its aid contributions. France accepts the payment of overseas student fees as aid, for example, where Britain does not. Other countries include payments for refugees in their aid budgets. The UK doesn’t.

See here for the full article at Yahoo! Talking Politics.

The Good News!

The UK Department for International Development (DfID) is honouring its commitment to increase aid spending to 0.7% of GDP by 2013. And it will fund the Schistosomiasis Control Initiative (SCI) with $25 million over the next five years. SCI is one of Giving What We Can’s top rated charities, with one year of preventative treatment for Schistosomiasis (’bilharzia’) costing just 50p. Development Secretary Andrew Mitchell highlights that this makes SCI’s work not only hugely cost-effective for healthcare, but also one of the most powerful ways to keep children in school:

Education is one of the best routes out of poverty, yet millions of children are unable to fully benefit from attending school because they are weakened by these diseases.

British aid will provide up to 75 million lifesaving treatments - ensuring that ill health doesn’t stop millions of the most vulnerable children getting a basic education and breaking the cycle of extreme poverty.

It’s a very positive sign that the British government are taking cost-effectiveness in development aid seriously. See here for the Guardian’s report on DfID’s pledge.

The Bad News.

DfID is, at the same time, doubling the amount of aid it channels to conflict-ridden states. This aid will now take up a third of all UK aid spending (previously, it was one quarter). Many working in the international development sector are angered by this militarisation of aid. Save the Children’s Patrick Watt asked:

“What is the real driver of aid allocation? Is it poverty, is it need and the ability to use money effectively or is it the agenda of the National Security Council? We do need to have a balanced approach to aid allocation that reflects the principles of the 2002 International Development Act which stipulates that all aid should be for poverty reduction.

“…[T]he countries that will lose out will be poor but stable countries like Ghana or Tanzania… You will end up in a slightly perverse situation, if we’re not careful, where countries with a lot of poor people that happen not to be on the geopolitical radar are losing out.”

Joan Ruddock MP also pressed David Cameron on the change, arguing that:

“I have always supported the case for greater conflict prevention. But conflict prevention needs to be understood and practised by the military themselves.”

David Cameron defended the switch against this charge, saying, “we’re mad if we don’t put money into mending broken states where so many of the problems of poverty come from.”

See here for the Guardian’s article into this ‘militarisation’ of aid.

Furthermore, the increase in aid will only begin in four years’ time. For millions of people, four years from now will be too late for them to receive life-saving medicine, get an education, receive adequate nutrition in early childhood… There are further fears, too:

the budget will stay fairly flat in the first three years of the review, and then jump by 28% in the fourth year. One expert said: “That is such an enormous jump, you have to question whether they seriously mean to do it.”

There are also fears about the impact of DfID cutting admin spending from £72m to £34m. The Guardian reports:

“There’s a danger of falling for the mythology of faceless bureaucrats in London, as if there are lots of people doing nothing very useful,” said a former senior diplomat.

“For example, a report comes in on human rights abuse and it sits in an in-tray because there’s not enough staff with quality time to sort out priorities and send the right stuff up to ministers in timely fashion, for decision and action. I’ve seen that sort of thing happen even on present staffing, so there are risks in cutting too hard.”

See here for the Guardian’s excellent article -which paints the new aid budget as moving Britain to a ’soft-power’ rather than ‘hard-power’ nation- from which those last quotes were taken.

The World Health Organisation (WHO) has produced its first ever report into Neglected Tropical Diseases (NTDs). It carries a hugely promising message: “It is entirely possible to control neglected tropical diseases. Aiming at their complete control and even elimination is fully justified.”

The report stresses that

There are already, “Good medicines are available for many of these diseases, and research continues to document their safety and efficacy when administered individually or in combination.”

The WHO report also highlights the cost-effectiveness of tackling NTDs, and how the benefits of such action would reach widely beyond healthcare. For example:

“On the basis of the estimated rate of return to education in Kenya, deworming is likely to increase the net present value of wages by more than US$ 40 per treated person. Benefit-to-cost ratio = 100. Deworming may increase adult income by 40%. The economic cost of trachoma in terms of lost productivity is estimated at US$ 2.9 billion annually.”

Here is a good starter article on the report, with a link to the report pdf itself in the first paragraph.

Here is the WHO’s own short article launching the report.

Andrew Mitchell is the new secretary of state for International Development. He has affirmed the government’s commitment to increase aid spending to 0.7% of GDP by 2013 (a target initially set by Labour). Mitchell has highlighted maternal and infant mortality, women’s empowerment and combating malaria as key priorities. Mitchell also wants the private sector to play a far greater role in development projects.

Mitchell has also, promisingly, stressed the importance of accountability, transparency and value for money. In an opening speech, he stated, “British aid pays for 5 million children in developing countries to go to school every day. That’s roughly the same number as go to primary school in Britain, yet it costs only 2.5% of what we spend here. That is real value for money.” An independent aid watchdog is to be set up, £100 million is to be diverted from less to more cost-effective projects, and a UKAid Transparency Guide will aim to ensure DFID publishes accessible, detailed information about its aid spending.

Aid agencies are generally supportive of these changes. There is some worry, however, about Mitchell’s ‘coherence agenda’, which may involve more aid money being spent by the Foreign Office on military-humanitarian projects such as those in Afghanistan. Patrick Watt from Save the Children commented, “We’d be concerned by any long-term trend in reduction of overseas development aid going to DFID. We’ve seen this taken to an extreme in the US where one-third of USAID money goes through the State Department or Pentagon.” Kathleen Chapman from Oxfam added, “We’ll push for the government to avoid militarizing aid,” said Chapman. “The top message needs to be that aid is focused on people who most need it.”

There’s a very good IRIN article about the outlook for UK aid here, while DFID has its own short article, and video of Mitchell’s speech, here.

TED online have recently posted this interesting video, in which Esther Duflo discusses the role of social experiments in fighting poverty.

And if such things interest you, the GWWC website also highlights some excellent essays, books and videos on the subject of development, just here.